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Law Enforcement: a Vital Partnership in the Public Health Approach to Gun Violence


Purpose of Review

To discuss the concerns, motivations, and accomplishments of the law enforcement community with respect to gun violence. To raise awareness of the scope of the problem of gun violence from the law enforcement perspective.

Recent Findings

Gun violence impacts civilians and the law enforcement community in different ways, with similar outcomes. A multidisciplinary approach of education, legislation, and enforcement may best impact trending US gun violence.


The law enforcement community can help to define gun violence as a public health crisis. Working relationships between the police, health care providers, legislators, and community leaders are extremely important in the national conversation about gun violence prevention.


Perhaps no group in America experiences the daily consequences of gun violence more than our nation’s law enforcement officers. Not only do we serve to protect our communities from crimes, but we also respond to acts of violence, investigate their causes, and arrest those who are responsible. Firearm-related crimes that result in injuries or fatalities extend these responsibilities far beyond the shooting when we are tasked with delivering life-altering news to a victims’ family or to provide comfort to a parent at these horrible moments of loss. Unfortunately, this task has become too common for us in communities across America.

Each of the authors of this chapter has professional experiences with guns and gun violence. We have each been shot at, threatened and we have shot back. We have all approached a dark vehicle in the middle of the night, or a domestic call not knowing what awaited us, and we have each stood at attention as a friend and colleague was lowered into the ground in a coffin draped with an American flag—an experience none of us want to repeat, but unfortunately all of us have. We have seen gun violence from both sides of the firearm. So, for us, the fight against gun violence is as foundational as the oaths we have taken to defend our country and our communities. For these reasons, like it is for the physicians, nurses, and public health researchers who have contributed to this this unique comprehensive work, this is our lane as well.

Approximately 82% of the US population lives in an urban area and that the burden of personal, societal, and economic costs of gun crimes is borne disproportionately by these areas [1•]. Recent data suggests that while gun violence has remained relatively constant over the last two decades, the problem in some jurisdictions continues to worsen [2] and there has been an upward trend since 2010. According to the nearly 70-member agencies of the Major Cities Chiefs Association (MCCA), surveyed in 2015 and 2016, homicides rose 15.6% and 9.8% respectively. While detractors point to a few cities responsible for leading this disturbing trend, the reality is that nearly two-thirds of MCCA cities experienced increases. Despite varying demographics, geography, politics, and economics, there is a common element in nearly all these cities: violent crime increase is being driven by increases in gun crime. According to the MCCA report, “…not only did the total number of homicides in the U.S. rise between 2010 and 2015; the percentage of homicides committed with a firearm also went up, from 68% in 2010 to 71% in 2015.” A similar trend occurred with aggravated assaults: more reported crimes and a higher percentage of them committed with a gun [3•].

There is no question that many in the law enforcement community believe that the number of Americans who are injured and killed constitute a true public health crisis, and we believe that there needs to be a plan to address this problem. However, the gun culture manifest in a large segment of the US population feels that certain approaches are illegitimate. The nexus of firearm crime due to the availability of illegal firearms, its relationship to the 2nd amendment of the US Constitution, and the current political climate makes gun violence a complicated societal and deeply political issue. Yet, law enforcement officers who have previously joined health care providers and public health researchers in using the public health approach to tackle other complicated problems, also feel that a multidisciplinary, public health approach could work even on this divisive topic.

In 1964, a landmark paper by Haddon specifically focused on the role of alcohol in motor vehicle crashes [4]. The results not only helped form the basis for modern driving while intoxicated laws and strategy but also served as the basis for the formation of the National Highway Traffic Safety Administration (NHTSA). Multiple public health initiatives followed that focused on reducing motor vehicle crashes. The approaches included education and legislation and have saved countless lives. The law enforcement community was integral in these outcomes by enforcing of the laws. Seatbelts, speed limits, vehicle design, roadway safety features, public education, and graduated drivers licensing programs all serve as prime examples of meaningful injury prevention programs that have used a public health approach to save lives from complicated, politically perilous problems that are deeply embedded in our society and culture. Why should our approach to gun violence be any different?

Although gun crime has increased in recent years, strategies to limit access to guns by those who should not be able to possess them have been met with suspicion in some circles. While recent polls suggest that most Americans favor universal background checks, only a few states have passed laws to systematically scrutinize all firearm purchases. Furthermore, HR 8, a federal universal background check bill which was advanced by the House of Representatives, has remained stalled in the Senate. In many jurisdictions, under the guise of “constitutional carry” law makers have loosened restrictions to own, possess, and conceal firearms. One must wonder what will motivate the American people for meaningful, sensible regulation of illegal firearms along a public health approach.

While our efforts as law enforcement officers are primarily focused on the response, investigation, and prosecution of criminals who commit acts of gun violence, several novel approaches to the problem of gun violence have demonstrated promising results. For example, a unique partnership between the Robert Wood Johnson School of Medicine and the Camden County Police Department recently published their experience on using sonic gunshot detection technology (ShotSpotter) to improve both the response to and prosecution of gun violence in Camden, NJ [5]. Theoretically, by improving response times and reducing the time interval from gunshot to entrance into both the trauma and law enforcement “systems,” both survival and prosecution are expected to improve. Additionally, the partnership between first responders and the health care system provides a successful framework for the public health approach described in this article.

Although originally designed to solely enforce the law, today’s law enforcement agency is charged with far more than that. Law enforcement agencies around the USA are engaged in various degrees in novel approaches to deterring gun violence, from developing novel approaches to detection equipment to deploying social workers into the field next to officers. However, what remains clear is that in the case of the crisis of gun violence in the USA, there is more work to be done.

Current Burden of Gun Violence in Urban Areas

As it has been stated in other sections, of the 40,000 gun-related deaths, 30,000 are suicides and 10,000 homicides. However, in addition to these deaths, there are more than 100,000 non-fatal injuries, each of these representing a devastated family and a survivor who will never be the same. Like trauma centers, law enforcement officers and agencies are deeply affected by each of these incidents.

Currently, law enforcement agencies across the USA have employed numerous strategies to try to reduce gun crime, including increasing penalties for repeat violent offenders, conducting hot-spot enforcement activities, establishing multi-agency and federal task forces, creating gang enforcement and other specialized units, and community policing initiatives, to name a few [6•]. Yet despite these efforts, the rate of crimes in which a firearm is used has remained relatively stable. Perhaps more concerning is a trend in most, but not all, metropolitan areas of an increasing number of aggravated assaults involving a firearm [7].

Although this paper focuses on interpersonal gun violence, suicide and “accidental” shootings are also issues that have become more commonplace and that we are seeing with increasing frequency. Both trauma surgeons and law enforcement officers bear the weight of these two issues associated with the negligent discharge of a firearm and some of the solutions described below may very well be applicable to both suicide and accidental shooting reduction by promoting improved gun safety. It is our hope that no matter the cause, that by virtue of the programs described in this issue, we are able to reduce the total number of bullet holes in this country.

Sensible Gun Policy Solutions Involving Law Enforcement

On behalf of the largest law enforcement agencies in the Nation, Major Cities Chiefs Association President and Montgomery County Police Chief J. Thomas Manger issued a statement in 2018 that continues to resonate today. In announcing a new policy statement that considered recent events, and was adopted by the Chiefs at their meeting, Chief Manger called on Congress to:

  1. 1.

    Adopt a universal background check for all gun sales and transfers.

  2. 2.

    Expand screening for prohibited buyers to include persons with violent mental health history.

  3. 3.

    Seek “Red Flag” measures to prevent guns from reaching persons who pose an imminent risk to themselves or others.

  4. 4.

    Urge legislation that permits court orders barring gun purchases in domestic violence cases.

  5. 5.

    Promote laws that encourage safe storage like Child Access Protection laws.

The new positions and policies are also reflective of lessons learned from recent tragic gun murders and pleas of both parents and youth from at Marjory Stoneman High School, in Parkland, FL, and from the survivors and law enforcement officers who witnessed them. The salient details from the MCCA regarding their legislative priorities are listed in Table 1 and the highlights of their gun violence policy are listed in Table 2.

Table 1 Legislative priorities of the Major Cities Chiefs Association
Table 2 Major Cities Chiefs Association policy statements

A Novel Approach: the Crime Gun Intelligence Center

As in so many disciplines and complex public health problems, novel solutions often come in the form of previously unelucidated collaborative efforts. One such solution involves a primarily law-enforcement-based technical integration solution: the Crime Gun Intelligence Center (CGIC) model. In short, a CGIC attempts to integrate multiple data streams in the criminal justice space to guide and improve both the investigation of and efforts against gun violence and those who use guns to facilitate criminal behavior. A CGIC is a data-sharing collaboration between a local police department; the US Bureau of Alcohol, Tobacco and Firearms (ATF); and a combination of other local resources like community prosecutors. In some jurisdictions, the CGICs are following the fusion center model with regard to the integration of public health and healthcare system resources to facilitate communication and investigation after an incident. This combination of technology, old-school crime fighting, and innovative analytics that integrates all the above with ballistic evidence also helps to identify previously thought unrelated crimes and to establish a nexus to those who commit gun crimes in our communities.

One data component that serves a vital role is the ATF’s National Integrated Ballistic Information Network (NIBIN). Put simply, NIBIN allows examination of a series of marks and grooves on firearm cartridges and bullets to allow the linkage of evidence from different gun crimes on a national level. The combination of NIBIN and a system known as eTRACE allows the law enforcement agency and CGIC to trace firearms from crime scene all the way back to the original purchaser. From a purely surgical perspective, NIBIN is the reason behind the change in surgical practice for when a missile (bullet) is encountered during surgical intervention. Gone are the days when we threw a bullet into a steel kidney basin just to hear the “clank” made so famous by fictional surgeons, supplanted by the gentle handling of the missile which is passed on to investigators by a strict chain of evidence that is required for today’s forensic technologies.

Relational Policing and Community Gun Violence

While still an aspirational goal in most communities, true relational policing has the potential for massive impact on gun violence in America’s communities. Relational policing describes recent a broad swathe of recent initiatives designed to bring the police closer to the community they serve. Too often, in the experience of the authors of this chapter, policing in America takes the form of an adversarial relationship with the communities in which we serve. Additionally, while “community policing” served as the buzz word and foundations for today’s idea of relational policing, the concept has been advanced into a much deeper, more meaningful, comprehensive look at the integration of the modern law enforcement agency into the community. In many jurisdictions, juxtaposed by their unique roles in the finalities of gun violence, large police and sheriff’s departments have found new common ground with the trauma centers and trauma providers in their communities. Each group, as represented by this diverse group of authors, has come to the clear realization that continuing to do things as we are now will yield little progress on the scourge of gun violence in our communities.

The idea of relational policing, and its potential mitigating effect of violence in communities, goes far beyond the presence of uniformed officers in and around the communities they serve. Relational policing is defined by a comprehensive approach not only to community participation, but to look, feel and truly understand the local community and all its parts. Relational policing includes efforts to make police departments look and sound much more like the communities with which they partner and certainly with which they must come together on the topic of mitigating gun violence. For example, and while this may seem superficial and by no means is related to the gun violence crisis, the Houston Police Department recently became the first in the nation to adopt a formal policy allowing its Sikh officer to wear their religious garb while on-duty and in uniform. The impact of a police officer who looks similar and who understands the culture of his community or is even a member of that community is not lost on the citizens that he/she is assigned to protect. Relational policing brings the law enforcement agency closer to the community it serves.

As relational policing continues to be developed by progressive law enforcement jurisdictions, so will novel linkages and programs that bring law enforcement and trauma leaders together to address the issues of violence that have risen to a true public health crisis. Community preparedness programs such as StopTheBleed and other “Violence Interrupter” programs may have made meaningful impacts, although we have much more work to do to study these interventions.


Gun violence continues to plague many American communities without regard for state and local boundaries, race, color, creed, sexual orientation, or religion. Gun violence remains a clear and present danger to the future of a healthy and prosperous USA and to the health and wellbeing of our citizens and law enforcement community. At almost every level—scientific, political, or relational—the law enforcement and trauma leaders of this country must continue to work on solutions to this very complicated problem. We can neither arrest nor operate our way out this current public health crisis. Yet, much like what we have for many other problems we have faced in public safety over the last half century, we believe that these two groups of powerful influencers—the law enforcement and the health care community—present in some form in every jurisdiction, must work together to continue to develop novel partnerships, programs and solutions to prevent gun violence.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1•

    Robertson LS. Federal funds and state motor vehicle deaths. J Public Health Policy. 1984;5(3):376–386. The work describes a successful multidisciplinary public health approach to motor vehicle trauma that has resulted in fewer injuries and deaths. This included enforcement of the laws by police.

  2. 2

    Federal Bureau of Investigation. 2018 Uniform crime report: national incident-based reporting system. https://ucr.fbi.gov/nibrs/2018. Accessed 12/9/2019.

  3. 3•

    Major Cities Chiefs Association, 2018 Report on violent crime, www.majorcitieschiefs.com, accessed November 10, 2019. A central report on violent crime in 2018.

  4. 4

    Haddon W Jr, Bradess V. Alcohol in the single vehicle fatal accident: experience of Westchester County, New York. J Am Med Assoc. 1959;169:1587–93.

  5. 5

    Goldenberg A, Rattigan D, Dalton M, Gaughan JP, Thomson JS, Remick K, et al. Use of ShotSpotter detection technology decreases prehospital time for patients sustaining gunshot wounds. J Trauma Acute Care Surg. 2019 Dec;87(6):1253–9.

  6. 6•

    Major Cities Chiefs Association; Gun Violence Initiative, www.mcca.org, accessed October 23, 2019. Suggestions from the law enforcement community identifying opportunities to decrease fire arm violence.

  7. 7

    Data compiled from 2010, 2011, 2012, 2013, 2014, and 2015 UCR Crime Reports, FBI. Tables referenced: “Murder,” Table 20; “Robbery,” Table 21; “Aggravated Assault,” Table 22. https://www.f bi.gov/about-us/cjis/ucr/crime-in-the-u.s.

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Author information

Correspondence to Alexander L. Eastman.

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Conflict of Interest

Dr. Eastman has nothing to disclose. Dr. McDonnell has nothing to disclose. Mr. Acevedo has nothing to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


The opinions of the authors expressed in this work do not represent official positions from the authors’ respective employers or their affiliated institutions.

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James McDonnell served as the elected Sheriff of Los Angeles County, CA.

This article is part of the Topical Collection on Gun Violence

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Eastman, A.L., Acevedo, A. & McDonnell, J. Law Enforcement: a Vital Partnership in the Public Health Approach to Gun Violence. Curr Trauma Rep (2020). https://doi.org/10.1007/s40719-020-00186-7

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  • Gun violence
  • Law enforcement
  • Public health
  • Relational policing
  • Violence prevention